Sharon C. Dagan

The applicant sought statutory accident benefits, including attendant care benefits, following the death of her husband in a motor vehicle accident.

The insurer requested that the applicant attend psychological and occupational therapy insurer's examinations (IEs) to assess her entitlement.

The applicant failed to attend the scheduled IEs, arguing the notices were deficient and the examinations were not reasonably necessary.

The Tribunal found the insurer's notices complied with section 44 of the Schedule and the requests were reasonable.

Consequently, the Tribunal held the applicant was barred from proceeding with her application for attendant care benefits and a related assessment plan pursuant to section 55(1)2 of the Schedule.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his claim for income replacement benefits and an award under Regulation 664.

The applicant argued that the adjudicator breached procedural fairness, made errors of fact and law, and that a different adjudicator should hear the reconsideration to avoid an apprehension of bias.

The Tribunal dismissed the request, finding that adjudicators are permitted to reconsider their own decisions, there was no breach of procedural fairness, and no errors of fact or law were made that would have led to a different result.

Specifically, the applicant failed to provide evidence of his pre-accident work experience to satisfy the test under s. 6(2)(b) of the Schedule.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The respondent insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans.

The Tribunal found that the applicant's physical and psychological injuries were predominantly minor and did not warrant removal from the MIG.

Two of the disputed treatment plans were found to be statute-barred as the application was commenced more than two years after the insurer's refusal.

The remaining chiropractic treatment plans were allowed subject to the MIG limits, while the claims for an in-home assessment and psychological assessment were denied.

The applicant sought a non-earner benefit and medical and rehabilitation benefits for custom orthotics, chiropractic treatment, and massage therapy following a motor vehicle accident.

The adjudicator found that the applicant failed to prove a complete inability to carry on a normal life, noting that his pre-accident activities were already severely limited by chronic pain and reliance on his wife for activities of daily living.

The adjudicator also dismissed the claims for medical and rehabilitation benefits, finding insufficient medical evidence to prove they were reasonable and necessary, and accepting the respondent's insurance examination evidence.

The insurer brought a motion to compel the applicant to attend six insurer examinations to assess his entitlement to post-104 week income replacement benefits, and to stay the arbitration pending his attendance.

The insurer also sought production of the applicant's employment file from 2006 to date.

The arbitrator found that four of the six requested examinations were reasonable and necessary, given the late production of voluminous medical records by the applicant that raised new psychological and neurological issues.

The arbitration was stayed pending the applicant's attendance at the four examinations.

The arbitrator also ordered the applicant to produce his employment file, but limited the scope to one year pre-accident to date.